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Uterine Bleeding
March 2002

Q. I am trying to conceive for the second time. I tried for a year the first time before getting pregnant on my own after taking clomid for several cycles and doing a HSG. For the entire year that I was trying (after going off the pill), I had spotting that would start around 10 to 12 days past ovulation and last for four or five days until I would get my period.

I am still experiencing this, and would like to understand why this is happening. Did this contribute to my difficulties getting pregnant? Even the months I took clomid and progesterone suppositories, I still had days of spotting before my period. The month before I conceived naturally, I had even more than five days of spotting, got my period, ovulated around day 12 and had a positive pregnancy test on day 26.

I also would like to know when is cycle day 1--the first day of bright red blood, or the first day of spotting? I also have a normal flow for about two to three days which tapers off into spotting for a couple days.

A. You are describing a pattern of irregular uterine bleeding, that is to say bleeding at times other than just during the menstrual cycle. We might review briefly the normal hormone sequence. The first day of menstrual bleeding is considered day 1 of that cycle when levels of estrogen and progesterone are low. The female hormones are controlled by the pituitary in the brain, which secretes FSH stimulating the ovary to once again produce estrogen.

The estrogen levels rise which allows the lining of the uterus to develop in preparation for conception. LH from the pituitary is released midcycle and ovulation occurs, followed by rising progesterone levels which causes the uterine lining to mature in order to support a fertilized ovum if pregnancy has occurred. If no pregnancy results, the hormone levels drop and the uterine lining is shed, which is recognized as menstrual bleeding.

The pattern you describe sounds like late cycle bleeding, that is, bleeding occurring after the time of ovulation. This can mean that progesterone levels were too low to support the uterine lining. The exact significance should be determined by your doctor with an exam and appropriate testing.



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